TABLE 3
SOURCE: Kristen Kucera.
studies, however, suggest that trauma to the brain
may have more severe outcomes and more significant
long-term consequences for infants and preschoolers
than for older children. A number of findings regard-
ing the language and memory effects of TBI in in-
fants, school-age children, and adolescents are also
consistent with the hypothesis that skills in a rapid
stage of development at the time of TBI were more
adversely affected than already well-established skills.
A study that determined the long-term outcome
of severe brain injury in preschoolers revealed that
none of the children who were younger than four
years old at the time of the severe brain injury were
able to live independently or work full-time in adult-
hood. Other studies also reported abnormalities fol-
lowing TBI in 40 percent of children with minimal or
no loss of consciousness.
Injury can have important consequences for fami-
ly functioning, which in turn adversely affects the
family’s ability to assist the child in achieving her full
potential. Most of these adverse effects are seen in
families with children who sustained severe head inju-
ry. Several studies have revealed that the level of fami-
ly functioning before the injury was a better predictor
of family functioning at one year after the injury than
the severity of the TBI. The researchers inferred that
family dysfunction prior to the injury event was likely
to continue following the injury. Parental overreac-
tion and family dysfunction were likely to exacerbate
the child’s emotional reaction to the injury. Poverty
can exacerbate these problems and further decrease
the level of functioning of children following TBI.
Burns
Burns also produce devastating results for child
development. The effects of the injury on the psycho-
logical and emotional health of children and the fam-
ily demonstrate inconsistent findings.
Studies conducted in the 1970s revealed that 50
percent of children showed signs of emotional distur-
bance several years after their injury. Studies in the
1980s indicated that the prevalence of these symp-
toms might be much lower and that the level of family
and child functioning prior to the injury were the
most important predictors of postburn adjustment
and coping. A survey of burned children in 1985
found psychosocial maladjustment in 15 percent of
the children. For some of the children and families,
however, psychological disturbance existed before
the injury and might have hindered emotional and
even physical recovery afterward. The premise that
visible scarring is more damaging than hidden burn
scars has not been studied well. Adaptation takes
place over a period of years. In the first couple of
years after the burn, children have developmental re-
gression, phobias, and various other symptoms.
These symptoms progressively resolve in the subse-
quent years.Parents are frequently stressed by the child’s be-
havior, depressed over the burn and the child’s fu-
ture, and have feelings of guilt regarding the
circumstances leading to the injury. Some research
has shown that parental stress clearly differentiated
parents of burned children from other parents; chil-
dren with better psychological adjustment come from
families that have higher levels of cohesion, indepen-
dence, and more open expressiveness. This has im-
portant implications for interventions as mothers and
burned children can be identified and given special
support at the time of the initial care for the child’s
injury.214 INJURIES